应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究*

目的 探讨应用肝脏影像报告与数据管理系统(LI-RADS)诊断肝细胞癌(HCC)的价值,以规范化HCC的影像学诊断。方法 对200例存在慢性乙型肝炎或/和肝硬化、酗酒、血清甲胎蛋白升高的HCC高风险人群行CT和MRI常规平扫和增强检查,依据LI-RADS v2017分级标准进行评定,由两名放射科医师进行盲法评定,1个月后,再由同一名医生进行再次评定,评估两次评定的同一性。在LI-RADS分级中,LR-1、LR-2被看作是良性病变,LR-4、LR-5和LR-5TIV为恶性病变,以组织病理学检查作为诊断的金标准,计算LI-RADS诊断的敏感性、特异性和准确性。结果 在200例肝脏病变患者,病理学检查诊断125例为HCC,27例为肝内胆管细胞癌,9例为肝转移癌,39例为良性病灶;运用LI-RADS分级,CT诊断17例为良性,151例为恶性,而MRI诊断17例为良性,169例为恶性;CT诊断两次评级的Kappa值为0.912 (P < 0.001),而MRI诊断图像的数据显示,两次评级的Kappa值为1.000 (P < 0.001),说明在MRI检查运用LI-RADS分级判断HCC的准确度比CT高;运用LI-RADS分级标准,CT诊断HCC的灵敏度、特异度和准确性分别为95.4%、81.2%和90.2%,而MRI诊断HCC的灵敏度、特异度和准确性分别为100%、85.4%和92.4%。结论 在CT和MR检查中应用LI-RADS分级评估可以提高诊断HCC的准确度,且可重复性好。在CT检查评定分为LR-3的病变,可能为HCC,建议重新检查MRI或随访,而经MRI检查仍然评定为LR-3的病变则需要密切随访。     

CT血管三维重建鉴别布加综合征与乙型肝炎肝硬化价值分析*

目的 研究CT血管三维重建对鉴别布加综合征(BCS)与乙型肝炎肝硬化的临床价值。方法 2017年3月～2020年3月我院诊治的BCS患者28例,乙型肝炎肝硬化患者46例,接受CT血管三维重建检查,记录两组CT三维重建检查影像学特点。采用Logistic多因素回归分析探讨各征象对诊断BCS的价值,并建立回归方程。采用受试者工作特征曲线(ROC)分析回归方程诊断BCS的应用价值。结果 BCS组肝内静脉侧支开放发生率为82.1%,显著高于肝硬化组的15.2%(P<0.05),奇静脉与腰升静脉交通发生率为46.4%,显著高于肝硬化组的10.9%(P<0.05),下腔静脉和肝静脉充盈缺损为85.7%和92.9%,显著高于肝硬化组的10.9%和8.7%(P<0.05);腹膜后静脉丛曲张为35.7%,显著高于肝硬化组的10.9%(P<0.05),尾状叶增大为64.3%,显著高于肝硬化组的6.5%(P<0.05),地图状/雪花样强化为82.1%,显著高于肝硬化组的6.5%(P<0.05),门脉期不均匀强化为85.7%,显著高于肝硬化组的13.0%(P<0.05);Logistic多因素分析显示肝内静脉侧支开放(95%CI=1.035～3.332,P=0.038)、奇静脉与腰升静脉交通(95%CI=1.203～2.296,P=0.002)、下腔静脉充盈缺损(95%CI=1.694～4.893,P=0.000)、肝静脉充盈缺损(95%CI=1.695～3.156,P=0.000)、尾状叶增大(95%CI=1.012～1.901,P=0.042)和门脉期不均匀强化(95%CI=1.234～2.916,P=0.004)是诊断BCS的独立指标;ROC分析结果显示我们建立的回归方程诊断BCS的AUC为0.888(95%CI=0.812～0.965,P=0.000),显著高于其他各征象诊断。结论 CT血管三维重建检查有助于鉴别BCS与乙型肝炎肝硬化,综合CT三维重建征象建立预测模型有助于对BCS患者的早期筛查和诊断。     

LI-RADS超声分类诊断肝脏占位性病变准确性分析

目的 探讨应用LI-RADS超声分类方法诊断肝脏占位性病变的准确性。方法 2018年1月～2019年9月我院经病理学检查诊断为肝脏占位性病变患者60例,均接受超声造影检查。按照LI-RADS分类方法,分别以LR-3(方法1)和LR-4a(方法2)作为为截断点,分析两种方法鉴别良恶性病变的效能。结果 在60例肝占位性病变患者中,综合诊断肝囊肿4例,肝血管瘤16例,肝脓肿8例,肝局灶性脂肪变9例,肝局灶性结节性增生9例,肝细胞癌8例,肝转移瘤6例;以病理学检查诊断为金标准,方法1诊断恶性病变22例,良性病变38例。方法 2诊断恶性病变14例,良性病变46例;方法1诊断的灵敏度、特异度和正确率分别为85.7%、78.2%和80.0%,而方法2则分别为78.6%、93.5%(P<0.05)和100.0%(P<0.05)。结论 采用LI-RADS 方法2分辨肝脏占位性病变的性质具有很高的准确性,其临床应用价值值得进一步研究。     

应用米兰标准微波消融治疗肝细胞癌患者预后及其影响因素分析*

目的 探讨应用米兰标准施行微波消融术(MWA)治疗肝细胞癌(HCC)患者影响生存的因素。方法 2013年1月～2016年12月我院消化内科住院的94例直径≤5 cm的HCC患者接受超声引导下MWA治疗,随访5年。分析不同HCC结节个数和不同肿瘤直径对总生存率(OS)和无进展生存率(PFS)的影响。结果 随访5年,本组HCC患者OS为64.9%,1 a和2 a 肿瘤复发率分别为12.8%和53.2%;HCC直径> 3 cm患者的PFS显著短于直径≤3 cm的患者(P=0.005),PFS≤2年的HCC患者OS显著低于PFS> 2年的患者(48.0%对 84.1%,P<0.001);多因素回归分析显示HCC直径> 3 cm (HR=0.42,95%CI:0.21～0.83,P=0.01)是MWA术后肿瘤复发的独立危险因素,而白细胞计数< 4.0×10⁹ /L (HR=0.38, 95%CI:0.18～0.84,P=0.017)和PFS≤2 年(HR=0.24, 95%CI:0.10～0.56,P=0.001)是影响HCC患者OS的独立危险因素。结论 直径> 3 cm的HCC患者PFS较短,但似乎不影响OS,因为大多数肝内复发的HCC患者仍然可进行重复MWA治疗。     

肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立*

目的 探讨存在LR-3类肝内结节的肝硬化患者恶性转变的危险因素,并在此基础上建立恶性转变预测模型。方法 2014年3月～2016年3月我院诊治的124例存在肝内LR-3类结节的肝硬化患者,规律随访进行磁共振成像(MRI)检查,对可疑病灶进行穿刺活检。应用多因素Logistic回归分析影响癌变的危险因素,并建立预测模型。结果 经随访60～78个月(平均74个月),120例患者完成随访,发现癌变24例(20.0%),另96例无癌变;癌变组有饮酒、吸烟、合并糖尿病、乙型肝炎病毒感染和酒精性肝炎者分别为91.7%、87.5%、75.0%、100.0%和41.7%,显著高于未癌变组(分别为45.8%、52.1%、41.7%、58.3%和20.8%,P<0.05);Cox风险回归分析显示,饮酒(HR=2.264,95%CI=1.597～3.210,P<0.001)、糖尿病(HR=1.294,95%CI=1.107～1.513,P=0.001)、乙型肝炎(HR=1.795,95%CI=1.329～2.561,P<0.001)和酒精性肝炎(HR=0.658,95%CI=0.552～0.784,P<0.001)是存在LR-3类病变结节的肝硬化患者癌变的独立危险因素;根据Cox多因素分析结果建立癌变预测模型,即Y=0.817X₁+0.258X₂+0.585X₃-0.419X₄(X₁=饮酒,X₂=糖尿病,X₃=乙型肝炎,X₄=酒精性肝炎)。经ROC分析显示,该模型判断LR-3类病变结节患者癌变风险的AUC为0.812(SE=0.064,95%CI=0.687～0.936,P<0.001),其敏感度为0.833,特异度为0.673。结论 了解危险因素可能对判断肝硬化患者肝内结节的性质有帮助,加强随访,必要时穿刺才是明确诊断的正确方法。     

MSCT与MRI动态增强扫描对高血供肝内胆管癌与肝细胞癌的诊断价值分析

目的 探讨多层螺旋计算机断层扫描(MSCT)与磁共振成像(MRI)动态增强扫描对高血供肝内胆管癌(ICC)和肝细胞癌(HCC)的诊断价值。方法 2018年1月～2019年6月我科诊治的70例原发性肝癌患者,均接受MSCT和MRI动态增强扫描。以手术后组织病理学检查诊断作为金标准,评估两种检查方法的诊断效能。结果 经手术后组织病理学检查,在70例原发性肝癌患者中,诊断ICC 12例,HCC 58例;MSCT检查显示HCC病灶动脉期强化、静脉期强化减退,延迟期持续强化减退;MRI多期扫描检查显示39例HCC患者病灶呈快进快出型强化,17例患者病灶呈快进慢出型强化,2例患者病灶呈慢进慢出型强化。MRI多期扫描发现9例ICC患者病灶呈慢进慢出型,3例患者病灶在动脉期和门脉期未出现明显强化,延迟期逐渐呈均匀性强化;MRI诊断HCC患者56例(96.6%),与CT诊断的53例(91.4%)比,无显著性差异(P>0.05),而诊断ICC患者9例(75.0%),显著高于CT诊断的7例(58.3%,P<0.05)。结论 在富血供的PLC患者,ICC和HCC的影像学表现有所差异,应用MRI增强扫描有利于提高对ICC的诊断检出率,值得临床积累经验和应用。     

肝细胞癌患者TACE治疗前后血清miR-145水平变化及其临床意义

目的 探讨肝细胞癌(HCC)患者在经导管动脉化疗栓塞术(TACE)治疗前后血清microRNA-145(miR-145)水平变化及其临床意义。方法 2013年1月～2015年12月我院收治的72例HCC患者和同期60例健康体检者,采用qRT-PCR法检测血清miR-145水平,采用ROC曲线分析血清miR-145和甲胎蛋白(AFP)预测不良预后的价值。结果 在治疗1个月末,16例(22.2 %)为PR,13例(18.1%)为SD,43例(59.7 %)为PD;HCC组血清miR-145水平为(0.59±0.25),显著低于对照组【(1.02±0.28),P＜0.05】,术后1个月,HCC患者血清miR-145水平为(0.81±0.26),显著高于术前(P＜0.05);不同性别、年龄、肿瘤直径、肿瘤分化、癌栓和Child-Pugh分级患者血清miR-145水平无显著性差异(P＞0.05),而不同TNM分级和术前AFP水平患者之间差异显著(P＜0.05); PD组血清miR-145水平为(0.86±0.21),显著高于PR组或SD组【分别为(0.62±0.19)和(0.75±0.19),P＜0.05】;随访3年,28例(38.9%)患者死亡,其中高miR-14 水平患者3 a生存率为75.6 %,显著高于低水平患者的41.9 %(x²=8.765,P＜0.05);血清miR-145、AFP和miR-145联合AFP预测HCC不良预后的曲线下面积分别为0.871、0.851和0.942,两者联合预测的敏感度为91.7 %,准确度为90.2%。结论 TACE术后检测血清miR-145水平可能预示HCC患者预后较好。     

荧光腹腔镜肝切除术与常规腹腔镜肝切除术治疗HCC患者效果比较

目的 研究荧光腹腔镜肝切除术与常规腹腔镜肝切除治疗肝细胞癌(HCC)患者的临床效果。方法 2014年8月～2017年8月我院收治的148例HCC患者被随机分为观察组74例和对照组74例,分别行荧光腹腔镜肝切除术和常规腹腔镜肝切除术。随访3年。结果 观察组切缘肿瘤细胞阳性率为2.7%,显著低于对照组的13.5%(x²=5.804,P=0.016);两组围术期胸腔积液、发热、切口感染、胆漏和腹腔出血等并发症发生率比较差异无统计学意义(P＞0.05);观察组6 m、1 a和2 a生存率分别为98.6%、94.6%和90.5%,与对照组的95.9%、93.2%和86.5%比,无显著性差异(P＞0.05),但3 a生存率为85.1%,显著高于对照组的70.3%(P＜0.05);观察组3 a肿瘤复发率为27.0%,显著低于对照组的47.3%(P＜0.05)。结论 与常规腹腔镜肝切除术比,采用荧光腹腔镜肝切除术能实现肿瘤切缘的可视化,保证肿瘤切缘安全,有利于提高HCC患者生存率。     

肝血管瘤、肝细胞癌和肝血管平滑肌脂肪瘤超声造影特点观察*

目的 探讨肝血管瘤(HCH)、肝细胞癌(HCC)和肝血管平滑肌脂肪瘤(HAML)患者肝内病灶超声造影特点。方法 2017年11月～2020年11月我院诊治的肝占位病变患者112例,所有患者入院后均在治疗前接受常规超声和超声造影检查,观察肝内病灶数目、大小、边界、回声、形态、血供等信息,同时观察超声造影检查过程中动脉期、门静脉期和延迟期病灶的增强模式。结果 经组织病理学检查诊断为HCH患者39例,HCC患者64例和HMAL患者9例;HCH患者女性占比为66.7%,显著高于HCC或HAML患者(分别为18.8%和33.3%,P＜0.05),HCC患者年龄为(57.5±5.8)岁,HMAL患者年龄为(55.3±5.1)岁,均显著大于HCH患者【(46.2±5.2)岁,P<0.05】,HCC患者存在HBV感染发生率为76.6%,显著高于HMAL患者的28.6%或HCH患者的12.8%(P<0.05);在普通超声检查,HCC病灶边界不清、实质呈低回声和混合回声占比分别为65.6%、43.8%和42.2%,显著高于HCH病灶的2.6%、10.3%和7.7%或HAML病灶的0.0%、11.1%和11.1%(P＜0.05),HCH、HCC和HAML患者肝内病灶数目、病灶大小、形态和血供比较,差异无统计学意义(P＞0.05);在超声造影检查方面,HCH病灶在动脉期呈高增强占比为92.3%,显著高于HCC病灶的87.5%或HMAL病灶的88.9%(P＜0.05),HCC病灶门静脉期和延迟期呈低增强占比分别为65.6%和90.6%,显著高于HCH病灶的5.1%和43.6%或HMAL病灶的11.1%和22.2%(P＜0.05)。结论 HAML、HCH和HCC病灶在超声检查方面各具特点,而超声造影检查更具诊断和鉴别诊断价值,值得进一步研究。     

超声造影对肝细胞癌与肝转移癌的鉴别诊断价值分析

目的 研究超声造影(CEUS)检查肝转移癌(LM)与肝细胞癌(HCC)的表现特征和鉴别诊断价值。方法 2016年～2019年就诊于我院的肝脏占位患者117例,常规行CEUS检查,分析比较HCC与LM病灶在增强模式、开始增强时间、达峰时间和减退时间等方面的异同。结果 在77例HCC 患者中,有79个病灶,在40例LM患者中,有41个病灶;HCC病灶呈I型 增强为2.5%,II型为26.6%,III型为70.9%,而LM病灶分别为36.6%、9.8%和53.7%,差异显著(P＜0.05);HCC病灶增强达峰时间和减退时间分别为(29.16±7.87)s和(51.89±22.80)s,与LM病灶的【(25.98±5.30)s和(37.49±10.68)s,P＜0.05 】。结论 HCC与LM病灶在CEUS表现有一定的差异,对鉴别诊断具有很大的价值。     

Systematic Training of Liver Imaging Reporting and Data System Magnetic Resonance Imaging v2018 can Improve the Diagnosis of Hepatocellular Carcinoma for Different Radiologists

Background and AimsLiver imaging reporting and data system (LI-RADS) provides standardized lexicon and categorization for diagnosing hepatocellular carcinoma (HCC). However, there is limited knowledge about the effect of LI-RADS training. We prospectively explored whether the systematic training of LI-RADS v2018 on magnetic resonance imaging (MRI) can effectively improve the diagnostic performances of different radiologists for HCC.MethodsA total of 20 visiting radiologists and the multiparametric MRI of 70 hepatic observations in 61 patients with high risk of HCC were included in this study. The LI-RADS v2018 training procedure included three times of thematic lectures (each lasting for 2.5 h) given by a professor specialized in imaging diagnosis of liver, with an interval of a month. After each seminar, the radiologists had a month to adopt the algorithm into their daily work. The diagnostic performances and interobserver agreements of these radiologists adopting the algorithm for HCC diagnosis before and after training were compared.ResultsA total of 20 radiologists (male/female, 12/8; with an average age of 36.75±4.99 years) were enrolled. After training, the interobserver agreements for the LI-RADS category for all radiologists (p=0.005) were increased. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of all radiologists for HCC diagnosis before and after training were 43% vs. 54%, 86% vs. 88%, 74% vs. 81%, 62% vs. 67%, and 65% vs. 71%, respectively. The diagnostic performances of all radiologists (p<0.001) showed improvement after training.ConclusionsThe systematic training of LI-RADS can effectively improve the diagnostic performances of radiologists with different experiences for HCC.     

应用超声单模态融合成像技术指导微波消融治疗原发性肝癌即时疗效评价的价值研究*

目的 研究超声单模态融合成像技术在微波消融治疗原发性肝癌(PLC)患者中的应用价值。方法 2018年3月～2019年12月我院诊治的88例PLC患者,其中44例采用超声单模态融合成像(观察组),另44例采用CT/MRI多模态融合成像(对照组)指导微波消融治疗。结果 观察组配准评估时间为(3.8±1.3)min,显著短于对照组【(5.2±1.7)min, P<0.05】,观察组和对照组融合成像成功率分别为63.6%和56.8%,无显著性差异(P>0.05);在44例观察组发现52个病灶,单模态融合成功36个病灶(69.2%),在44例对照组发现54个病灶,多模态融合成功32个病灶(59.3%),两组病灶融合成功率比较,无显著性差异(P>0.05);两组肿瘤完全消融率分别为97.7%和93.2%,无显著性差异(P>0.05);观察组消融治疗后发热、局部疼痛、胆道出血和胆漏并发症发生率分别为9.1%、20.5%、4.5%和0.0%,与对照组的13.6%、27.3%、9.1%和2.3%比,差异无统计学意义(P>0.05);随访3～20个月,观察组生存32例(72.7%),总体生存(OS)为15.1(5.0,20.0)个月,无进展生存(PFS)为12.8(4.9,20.0)个月,对照组生存32例(72.7%),OS为14.2(4.8,20.0)个月,PFS为13.3(4.7,20.2)个月(Log rank x²=0.592, P=0.442;x²=1.103,P=0.294)。结论 超声单模态融合成像与CT/MRI多模态融合成像均可用于指导微波消融治疗PLC患者,但超声单模态融合成像更为简便,经济,可提供即时影像学资料,为后续治疗提供依据。     

Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?

BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC). Diffusionweighted imaging(DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI) for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity(SE), specificity(SP), accuracy(AC), positive predictive value(PPV), and negative predictive value(NPV) of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR-4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%,75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSION LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.     

LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study

Introduction and objectivesThe liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center.Materials and methodsProspective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1).ResultsOf 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion.ConclusionsLI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.     

Alcohol,postprandial plasma glucose,and prognosis of hepatocellular carcinoma

AIM:To identify factors associated with prognosis of hepatocellular carcinoma(HCC) after initial therapy.METHODS:A total of 377 HCC patients who were newly treated at Katsushika Medical Center,Japan from January 2000 to December 2009 and followed up for > 2 years,or died during follow-up,were enrolled.The factors related to survival were first analyzed in 377 patients with HCC tumor stage T1-T4 using multivariate Cox proportional hazards regression analysis.A similar analysis was performed in 282 patients with tumor stage T1-T3.Additionally,factors associated with the period between initial and subsequent therapy were examined in 144 patients who did not show local recurrence.Finally,214 HCC stage T1-T3 patients who died during the observation period were classified into four groups according to their alcohol consumption and postprandial glucose levels,and differences in their causes of death were examined.RESULTS:On multivariate Cox proportional hazards regression analysis,the following were significantly associated with survival:underlying liver disease stage [non-cirrhosis/Child-Pugh A vs B/C,hazard ratio(HR):0.603,95% CI:0.417-0.874,P = 0.0079],HCC stage(T1/T2 vs T3/T4,HR:0.447,95% CI:0.347-0.576,P < 0.0001),and mean postprandial plasma glucose after initial therapy(< 200 vs ≥ 200 mg/dL,HR:0.181,95% CI:0.067-0.488,P = 0.0008).In T1-T3 patients,uninterrupted alcohol consumption after initial therapy(no vs yes,HR:0.641,95% CI:0.469-0.877,P = 0.0055) was significant in addition to underlying liver disease stage(non-cirrhosis/Child-Pugh A vs B/C,HR:0649,95% CI:0.476-0.885,P = 0.0068),HCC stage(T1 vs T2/T3,HR:0.788,95% CI:0.653-0.945,P = 0.0108),and mean postprandial plasma glucose after initial therapy(< 200 mg/dL vs ≥ 200 mg/dL,HR:0.502,95% CI:0.337-0.747,P = 0.0005).In patients without local recurrence,time from initial to subsequent therapy for newly emerging HCC was significantly longer in the "postprandial glucose within 200 mg/dL group" than the "postprandial glucose > 200 mg/dL group"(l     

超声造影联合血清CA19-9鉴别诊断胆管细胞癌与肝细胞癌应用研究

目的 探讨肝内胆管细胞癌(ICC)与肝细胞癌(HCC)患者超声造影(CEUS)和血清糖类抗原19-9(CA19-9)水平变化特征。方法 经组织病理学检查诊断的ICC患者48例和HCC患者78例,进行CEUS检查,常规检测血清CA19-9。建立鉴别诊断ICC与HCC的多指标二元Logistic回归方程,探索其诊断ICC的价值。结果 45.8%ICC患者以肿瘤周围环状增强为主,显著高于HCC患者的2.6%(P<0.05);58.3%ICC患者造影剂显著廓清,而94.9% HCC呈弱或无廓清(P <0.05);ICC组廓清时间为(54.6±10.2)s,显著早于HCC组【(76.1±25.1)s,P <0.05】;72.9%ICC患者血清CA19-9升高,显著高于HCC组的19.2%(P<0.05);建立多指标联合的二元Logistic诊断模型方程为:Logit(P)=-4.030+2.640×增强模式+2.486×廓清时间+2.579×廓清程度+2.731×血清CA19-9 (U/ml),该模型识别ICC的AUC为0.943,其敏感度和特异度分别为79.2%和93.6%。结论 熟悉ICC与HCC的超声造影表现特征,结合血清CA19-9水平,可以帮助鉴别这两种肿瘤。     

Expanding the Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic population: performance and reliability of LI-RADS for distinguishing hepatocellular carcinoma (HCC) from non-HCC primary liver carcinoma in patients who do not meet strict LI-RADS high-risk criteria

BackgroundHepatocellular carcinoma (HCC) can be diagnosed using imaging criteria in patients at high-risk for HCC, according to Liver Imaging Reporting and Data System (LI-RADS) guidelines. The aim of this study was to determine the diagnostic performance and inter-rater reliability (IRR) of LI-RADS v2018 for differentiating HCC from non-HCC primary liver carcinoma (PLC), in patients who are at increased risk for HCC but not included in the LI-RADS ‘high-risk’ population.MethodsThis retrospective HIPAA-compliant study included a 10-year experience of pathologically-proven PLC at two liver transplant centers, and included patients with non-cirrhotic hepatitis C infection, non-cirrhotic non-alcoholic fatty liver disease, and fibrosis. Two readers evaluated each lesion and assigned an overall LI-RADS diagnostic category, additionally scoring all major, LR-M, and ancillary features.ResultsThe final study cohort consisted of 27 HCCs and 104 non-HCC PLC in 131 patients. The specificity of a ‘definite HCC’ designation was 97% for reader 1 and 100% for reader 2. The IRR was fair for overall LI-RADS category and substantial for most major features.ConclusionIn a population at increased risk for HCC but not currently included in the LI-RADS ‘high-risk’ population, LI-RADS v2018 demonstrated very high specificity for distinguishing pathologically-proven HCC from non-HCC PLC.